Influence of Community-Level Factors on Health Care Provider Recommendations for HPV Vaccine

INTRODUCTION Parents who receive a recommendation for the human papillomavirus (HPV) vaccine from a health care provider (HCP) are more likely to accept vaccination for their children. HPV vaccine coverage varies widely by geography and community-level factors; however, little is known about how HCP recommendations for HPV vaccines vary at the community level. In this study, we examined the association between community-level factors and receipt of a recommendation for the HPV vaccine. We also examined the interaction between community-level factors and patient characteristics. METHODS We conducted a multilevel multivariable weighted logistic regression analysis of 2014 to 2019 National Immunization Survey-Teen (NIS-Teen) linked to 2010 US Census Bureau data at the zip code level. RESULTS Parents’ report of receipt of a recommendation for the HPV vaccine was associated with higher population density (adjusted odds ratio [aOR], 1.20; 95% CI, 1.10–1.30), higher community-level education (aOR, 1.37; 95% CI, 1.23–1.52), and higher rates of unemployment (aOR, 1.14; 95% CI, 1.04–1.25). There was also a statistically significant interaction between adolescent race and ethnicity and zip code poverty status: non-white adolescents living in high-poverty zip codes were 1.16 times more likely (95% CI, 1.02–1.32) to have received an HCP recommendation for the HPV vaccine compared with non-white adolescents in low-poverty zip codes. CONCLUSIONS Our findings indicate that evidence-based interventions that focus on HCPs or are practice based may have the greatest impact in nonurban areas. Efforts to promote vaccine recommendations to all age-eligible patients by HCPs will also promote more equitable coverage.